most extensive law on how employers must tx health care workers and clients infected w/ HIV

gives individuals the opportunity to decide whether to disclose their disability

Emergency MEdical Treatmeant & Active LAbor Act does what?

provides that when a client comes to the ED or the hospital, an appropriate medical screening occurs w/in the hospital's capacity

The hospital is not to discharge or transfer the client until the condition stabilizes in emergency situations

Enacted as result of clients' being transferred from private hospitals to public hospitals w/o appropriate screening & stabilization (pt dumping)

Mental Health Act

Forbids health plans from placing lifetime or annual limits on mental health coverage that are less generous than those placed on medical or surgical benifits

people w/ mental health issues need to have same coverage as you or I would have w/ surgical procedures

patient self determination act:

requires health care insitutions to provide written info to clients concerning the clients rights under state law to make decisions, including the right to reufse tx and formulate advance directives; the clients record must contain doc. whether the client has signed an advance directive

a part of advance directives you need to know is decisional capacity. what is it?

ability to make right choices for oneself as it relates to medical care

You are required by law to ask if your pt has any direct directives. Is it ok if its not in the chart?

If they do you must have a copy for the medical record.

what are the different types of advance directives?

Living wills

Durable power of Attorney for health care

What is a living will?

represents written doc. that direct tx in accordance w/ a client's ishes in the event of a terminal illness or condition; they are often difficult to interpert and not clinically specific in unforseen cirucumstances

Durable power of attorney for health, what is it?

Legal doc. that designates a person or persons of one's choosing to make helath care decisions when the client is no longer able to make decisons on his or her own behalf; the agent makes health care tx decisions based on the client's wishes

DNR orders should be written or verbal orders?

written

what is the Uniform Anatomical Gift Act?

an individual who is at least 18 years of age ahs the right to make an organ donation

Gift must be in writing w/ their signature

qualified health care provider has to ask each client over age of 18 whether client is a organ/tissue donor

adhere to the cleint's wishes if they wan ttheir body donated for science

HIPPA.... oh HIPPA

provides rights to clients & protects employees

protects idnividuals from losing their health insureance when changing jobs by providing portability

clients have rights to use and disclose health info, inspect and copy their medical records, amend mistaken or incomplete info

limits who is able to access clients records

privacy: the right of clients to keep info about themselves from being disclosed

confidentiality: how health care providerstx client's private info once it has been disclosed to others

when can restraints be used?

only to ensure physical safety of the resident or other residents

when less restirctive interventions are not successful

only on the written order of a pysician or health care provider (specific start/end tiems)

Define licensure.

state board of nursing license are registerd nurses in the state in which they practice

all states use NCLEX

what are the good samaritan laws?

providing emergency assistance at the site of an accident

limit liability and offer legal immunity to nurses who help at the scene of an accident

some state requires nurses to stop at accidens to help

what are public health laws?

State legislatures enact statutes under the health code, which describes the reporting laws for communicable diseases, school immunizations, and laws intended to promote health and reduce health risks in communities

Purpuses of public health laws are protection of the public’s health, advocating for the rights of people, regulating health care and health care financing, and ensuring professional accountability for the care

provided

Laws include reporting suspected abuse and neglect, reporting communicable diseases, ensuring that clients in the community have received required immunizations and reporting of other health-related issues enacted to protect the public’s health

what is the uniform determination of death act? and the whole brain standard?

Health care providers can use either the cardiopulmonary definition or the whole-brain definition to determine death

Whole-brain standard: requires irreversible cessation of all functions of the entire brain, including the brain stem

To facilitate the recovery of organs for transplantation If a physician is not present on the floor, to RNs are required to verify and the name of the second RN needs to be charted in the notes of the primary nurse

There are certain things that have to be charted, so look through your hospital policies to determine what is required

what is a physician assissted suicide?

Oregon Death With Dignity Act: a competent individual with a terminal disease could make an oral and written request for medication to end his or her

life in a humane and dignified manner

Terminal disease: incurable and irreversible disease that has been medically confirmed and will, within reasonable medical judgment, produce death

within 6 months

Supreme Court holds that there is no fundamental constitutional right to assisted suicide but it does not prevent the states from passing legislation to legalize assisted suicide

Feeding tubes and assisted suicide: courts have hesitated to authorize withdrawals of feeding tubes unless there is very clear evidence that the client previously expressed a preference against a feeding tube

define common law.

judicial decisions made in courts when individual legal cases are decided (informed consent, right to refuse treatment) - where most court cases come from

define negilgence

conduct that falls below a standard of care

Nurse can be held liable

Not doing something you should have done

define malpractice. how does one avoid?

the failure to use that degree of skill or learning ordinarily used under the same or similar circumstances by members of the nursing profession

A signed consent form is required for all routine treatment, hazardous procedures, some treatment programs and research involving clients

If a client is deaf, illiterate, or speaks a foreign language, there needs to be an official interpreter to explain the terms of consent - don’t use a family member or another nurse (unless the nurse has been

authorized)

Physician’s responsibility to explain the procedure, witness the signing of the consent

You can get consent for giving blood because you will be the one giving the blood

Nursing students and the law.

If a student harms a client as a direct result of his or her actions or lack of action, the student, instructor, hospital or health care facility, and university or educational institution generally share the

liability for the incorrect action

Nursing students should never be assigned tasks for which they are unprepared

When nursing students work as nursing assistants or nurse’s aides when not attending classes, they should not perform tasks that do not appear in a job description for a nurse’s aide or assistant

what is malpractice insurance?

A contract between the nurse and the insurance company

Provides for a defense when a nurse is in a lawsuit involving professional negligence or medical malpractice

Nurses employed by health care institutions generally are covered by that institution’s insurance and do not need to purchase any supplemental insurance unless the nurse plans to practice nursing outside of the

employing institution

Sara recommends having your own

what are things to be aware of when floating?

Based on census load and client acuities

Nurses who float need to inform the supervisor of an lack of experience in caring for the type of clients on the nursing unit

They need to request and receive an orientation to the unit

Supervisors are liable if they give a staff nurse an assignment he or she cannot safely handle

wahts a physician order?

Nurses follow orders unless they believe an order is in error or harmful

You can take telephone orders but the physician needs to write the order if they are right there on your floor giving a verbal order

Telephone order: Dr.’s name, repeat back and order verification by the physician within 24 hours

Date, time, and sticker

The physician is responsible for directing medical treatment

If an order is found to be erroneous or harmful, clarify with the physician; if the physician confirms the order and you still find it questionable, take it to your supervisor or follow the chain of command

Inform the physician of any changes in the client’s condition and document the notification, the physician’s response, the follow-up and the client’s response

define risk management.

system of ensuring appropriate nursing care that attempts to identify potential hazards and eliminate them before harm occurs

Steps

-Identification of possible risks

-Analyzing possible risks

-Acting to reduce the risks

-Evaluating the steps taken

Tools

-Incident or occurrence repor

Provides a database for further investigation in an attempt to determine deviations from standards of care and corrective measures needed to prevent recurrence and to alert risk management to a potential claim situation

Never document in the client’s medical record that an occurrence report was completed because the report is confidential and separate from the medical record Professional involvement: nurses need to be involved in their professional organizations and on committees that define the standards of care for nursing practice